Friday, July 27, 2012

﻿﻿﻿STANFORD, Calif.--A liver failure patient is enjoying a new lease on life after Stanford surgeons transplanted a portion of her sister’s liver, which later regenerated into the full-size organ.

At 48, Judith Lattin was diagnosed with liver failure. Over the next
nine years, Lattin fought that condition and its complications, enduring
procedures and an unpleasant regimen of medications to control a
bleeding esophagus, an enlarged spleen and major vein blockages. She was
unable to walk at times, but she was not sick enough to be high on the
list for a transplant.

She nearly lost all hope when doctors told her that the complications
stemming from her liver disease made them uncomfortable with trying a
transplant.

But then she met with the liver transplant team at
Stanford Hospital & Clinics, led by surgeons who trained with
Thomas Starzl, the American physician who pioneered successful liver
transplantation. For Lattin, that changed everything. At her first
meeting with Stanford’s chief of clinical transplantation, Waldo Concepcion,
MD, “He said, ‘Yes,’ they could do it, and there was hope. I saw light
at the end of the tunnel again,” Lattin said. “When you’ve been told
that surgery is not an option for you, that’s basically a death
sentence. It can be a very uncomfortable death. I had seen that as
inevitable for me.”

But, Lattin still faced another obstacle — where and how to find a kidney donor. According to the United Network for Organ Sharing (UNOS),
while the waiting list for liver donors is continually growing and
currently averages between 16,000 and 18,000, the number of available
deceased-donor livers has been stable at about 6,000 each year for the
last decade. One in seven patients dies before receiving a new liver.
There is no equivalent of kidney dialysis or cardiac-assist devices for
the liver.

Luckily, Stanford was willing to do something else that many other
hospitals would or could not: use a piece of Lattin’s sister’s liver as a
transplant. Instead of having to wait on the list for a deceased-donor
liver, Lattin could get that life-saving transplant as soon as
Stanford’s team approved the donation from Lattin’s sister, Christine
Webb. She was nine years younger and in good health, a strong candidate
for the procedure.

At about 3 ½ pounds, the liver is the body’s largest solid organ by
weight. Its functions are crucial. It detoxifies the blood, stores
vitamins, breaks down fats and sugars, generates hormones and, most
vital when surgery is involved, it produces the substance that clots
blood. It is also the one organ in the body whose tissues respond to
loss by regrowing to restore the organ’s original volume. That
remarkable quality is what enables someone to give away as much as 60
percent of a liver without repercussions, assuming the surgery is done
well. For that to happen, surgeons must control bleeding in an organ
that’s rich with blood vessels and pumping through 1 ½ quarts of blood
each minute.

“It’s a challenging, difficult surgery,” said Stanford Transplant Division Chief Carlos Esquivel,
MD, PhD. “The risk of life-threatening hemorrhage is ever present, but
we do this because there aren’t enough organs to go around.”

Despite this, Lattin and Webb were confident. “I had faith in the
Stanford medical team that took care of me,” Webb said. “I knew that
they were some of the best in the world, and that they don’t go into
these surgeries lightly at all. I knew they would leave nothing
unchecked, so I really trusted them.”

Only the most senior surgeons are allowed to do this type of operation,
Esquivel said. The surgery to remove the diseased liver and the surgery
to remove the donor liver portion take place simultaneously, followed
by the surgery to connect the transplant, so Esquivel, Concepcion and
their colleague, C. Andrew Bonham, MD, all worked the sisters’ surgery day.

The living donor procedure emerged in the late 1990s. Stanford performs
three to five living donor transplants each year and 50 to 60 deceased
donor liver transplants each year; its government-reported results place
it in the top ranks for safety and survival. In addition to the wisdom
gained from doing many procedures, advances in imaging used by Stanford
surgeons also have improved safety, said Walid Ayoub,
MD, who has been Lattin’s pre- and post-transplant hepatologist. With
that imaging, “surgeons can see all the vessels ahead of time. They have
a road map of the liver that allows them to stay clear of large veins
and partition the liver safely.”

The team also uses instrumentation and tools to reduce blood loss, and
it carefully calculates just how much liver to take. Every step has been
developed to protect the donor and recipient.

Lattin’s and Webb’s operations took place on Dec. 20, 2010. Lattin was
in the hospital for a month. Webb was released after four days. Lattin
lives carefully, following the rules for her medication, diet and
exercise. “I have energy to do things,” she said. “I have just so much
more of a joy for life. I waited nine years for a transplant, and I
didn’t realize just how much I had declined until after transplant when I
started to feel so much better, and then I just started to do things.”

Webb, too, felt rewarded following the surgery. “There’s not a feeling
in the world that is better than when doctors come to you and say, ‘You
saved two people.’ I saved my sister, but I also saved the person who
will now get the deceased donor liver my sister won’t need. It really
brings it home when you think about it that way.”

A charming love story that is worth watching again ... and again. I've often wondered what would be the perfect plot. This one is near perfect because it adds the querkiness of personality with the charm of a love story. While the movie has its bad guys and intrigue, the main plot surrounds its main three characters who frankly are "nice" people. It's refreshing to find characters with strong values. I've seen the movie directed by Lasse Hallstrom; now I'd like to read the book by Paul Torday.

This is how Redbox described the movie story:
Dr. Alfred Jones (Ewan McGregor), a fisheries scientist in London, is approached by a mysterious sheikh (Amr Waked)about an outlandish plan to introduce the sport of salmon fishing into the desert in Yemen. The Sheikh's absurd vision of bringing faith and hope to his people fails to resonate with the faithless, unhappy Brit. However, after initially refusing the proposal, Dr. Jones is swayed by the British government, the Sheikh and the Sheikh's glamorous real estate rep Harriet (Emily Blunt)into accepting the job. The result is a ridiculous look at the dysfunction of government bureaucracy and the importance of faith in the face of impossibility.

New book empowers millions of asthma sufferers to take control over the disease

More than 34 million Americans have been diagnosed with asthma some
time during their life, of which roughly one-third are under the age of
18. Dr. Stephen Apaliski, MD, an expert in the field of Pediatrics and
Allergy and Immunology, has found in his 30 years of experience that for
as many individuals who live with asthma, few really have it under
control, leading to further health complications and death. In his new
book, Beating Asthma: Seven Simple Principles, Dr. Apaliski teaches the
important basics of asthma care, empowering readers with the information
needed to take full control of their own, or a loved one’s asthmatic
condition.

“When questioned about their asthma, 71% of patients say it is well or
completely controlled,” says Dr. Apaliski. “When these same patients
were analyzed using objective measures of control, only 29% were well
controlled, so 71% were, in fact, poorly controlled. When not in
control, patients’ quality of life is greatly reduced, and they are
faced with potential emergency room visits, poor sleep, missing school
or work, medication overuse, and depression.”

The lack of knowledge and understanding of asthma is coupled with the
fact that there are simply not enough allergists and other asthma
specialists to care for all those who deal with the condition. With the
release of Beating Asthma: Seven Simple Principles, Dr. Apaliski raises
awareness of the standard of care needed for asthma sufferers so they
will come to expect nothing less – and hopefully combat the nearly 4,000
deaths that asthma causes each year.

Beating Asthma: Seven Simple Principles empowers asthma sufferers and their caregivers to gain better control over their condition buy paying attention to the 7 P’s:

Problem – understand how asthma works and know the basics of the condition
Prevention – avoid those things in your environment that trigger asthma
Pulmonary function tests – Know how well your lungs are functioning and use this information to guide your treatment plan
Pharmaceuticals – know that medication is an essential part of keeping your asthma under control
Plan – set your asthma action plan, a roadmap that tells you when and what to do when things go wrong
Patient-Physician – having open communications with your physician is a crucial part of treating asthma
Positive mindset – remaining optimistic, taking ownership of your
responsibilities to treat asthma, and becoming dedicated to keeping
control over the position will increase quality of life amongst asthma
sufferers

“I have believed for years that people with asthma and any other
chronic condition are best served by being empowered and developing a
great relationship with a good, empathetic, and caring physician,” adds
Dr. Apaliski.

Dr. Apaliski has been a practicing physician for over 30 years. He
first trained as a pediatrician at the Children’s Hospital of Pittsburgh
and later as an allergist at Wilford Hall United States Air Force
Medical Center in San Antonio, Texas. In 1990, he served as a flight
surgeon in the first Gulf War.

Dr. Apaliski is Board Certified in Pediatrics as well as Allergy and
Immunology. In addition, he is a Fellow of the American College of
Allergy and Immunology and a Board Member of the Allergy and Asthma
Foundation of America—Texas chapter. He is also certified by the
Association of Clinical Research Professionals as a Certified Physician
Investigator. In addition to seeing patients in his medical practice at
the Allergy & Asthma Centers of the Metroplex and conducting
Clinical Trials as the Medical Director of Discovery Trials-Arlington,
Dr. Apaliski is on the medical staff at THR Arlington Memorial Hospital
in Arlington, Texas.

Dr. Apaliski is also a speaker for various pharmaceutical companies,
helping to educate physicians and other health care providers about the
diagnosis and treatment of asthma and allergic diseases.

Thursday, July 26, 2012

ANN ARBOR, Mich. — A unique University of Michigan
Health System program that helps older patients transition from the
hospital to sub-acute care facilities has significantly reduced hospital
stays and readmissions, according to new findings published in the
Journal of the American Medical Directors Association.

Creating seamless patient transfers between hospitals and long-term
care facilities has become a growing national concern. Previously
reported studies have shown that these patients are particularly
vulnerable to medication errors, hospital readmissions and other adverse
effects on their care.

The six-year-old UMHS Sub-Acute Care Service –
which coordinates care between the hospital and care facilities
commonly called nursing homes – has proven a successful model of
providing safe transitions for hospitalized patients. The average length
of stay at UMHS before transfer to a skilled nursing facility dropped
from 10.6 days to eight days, and hospital inpatient stays for patients
in the program were reduced by nearly 2,908 days a year, authors say.

The findings come as new Medicare data released this month show that
hospital readmission rates are stubbornly stagnant, costing Medicare
$17.5 billion in inpatient spending. In October, Medicare will begin to
penalize hospitals with higher than expected readmission rates, a
mandate of new federal health laws.

“The data presented by Joshi and colleagues are compelling and the
program ought to be monitored as a potential model for other health
systems,” reads the editorial, titled “Climbing out of the Black Hole of
Subacute Care.”

The UMHS sub-acute care program involves a close partnership between
UMHS and selected skilled nursing facilities in the Ann Arbor area. It
has dramatically changed the relationship between the hospital and
facilities by deploying U-M physicians and nurse practitioners to
skilled nursing facility partners. This U-M team follows patients after
discharge and manages their care on-site.

“These patients are often elderly with chronic illness and other health
concerns and require medical care and rehabilitation in skilled nursing
facilities after hospitalization,” says Joshi, who is director of the
sub-acute program and a clinical instructor in the geriatric medicine
division of the U-M Medical School’s Department of Internal Medicine.

“We aimed to break down the silos that are such a big problem in
healthcare and improve the continuity of care. We found that an
investment like this by a large health system does produce returns by
improving the overall quality of coordinated care for patients
discharged to care facilities.”

Another critical piece of the sub-acute service is enhanced
communication. The slower-paced setting of the care facility grants
patients and their families more face time with physicians, whereas
conversations may seem “rushed” in hospitals, Joshi says. This helps
prevent misunderstandings over patient care.

The UMHS program also coordinates access to electronic health records
between the hospital and facility, including inpatient notes, consultant
reports, medication lists and allergies to avoid errors that could lead
to hospital readmissions. When there is a “bounce back” – a readmission
to the hospital from the nursing facility - easy access to data avoids
confusion among hospital physicians on why the patient may have
returned, the authors note.

Children presenting with behavior disorders often have associated
reading/learning difficulties and are commonly characterized as being
difficult children by their teachers and parents. ADD (attention deficit
disorder), ADHD (attention deficit disorder hyperactivity), LD
(learning disabilities), ODD (oppositional defiant disorder) and
Dyslexia (difficulty deciphering symbols) are a few of the diagnosis
that have been used to identify these children. Typically, it’s the
child’s pediatrician, pediatric psychiatrist and/or neurologist who
routinely prescribe medications: Ritalin, Concerta, Adderall and/or
Prozac to name a few, used to create order and quiet in a child’s
behavior.

Understandably, professionals are pressured to find answers for these
children with behavioral and associated reading/learning problems. The
school system and individual teachers are also pressured to create an
environment where these children labeled as lazy, a class clown, day
dreamer, slow, or uncooperative, can become socially and academically
functional within the mainstream classroom. Medication may promote a
child’s behavior to be more predictable and even appear to cause a child
to stay on task better. However, if the underlying problems children
experience are not medical in nature, these children will not learn or
read any easier. In fact, they may become frustrated because they don’t
feel right not knowing what’s wrong with them. Side effects of
medications may create additional change in how children feel resulting
in fatigue, restlessness, loss of appetite and a feeling of despair.
Medicating without success reinforces a child to feel unstable about
them self.

Medications may seem to cause less disruption in class and children may
appear to better stay on level. However, if what was thought to be a
chemical imbalance is truly a behavioral vision disorder, he will still
not be comfortable processing visual information.

Children suffering from a behavioral vision disorder commonly have
difficulty converging their eyes inward (inefficiency turning eyes
inward), have difficulty focusing (inefficiency identifying) and are not
be able to track (follow from one point to another). Misdiagnosis may
not only support visual inaccuracy, it can diminish self esteem and even
develop into the “Failure Syndrome.” Children with this syndrome
believe that in not being able to perform a task correctly, they are
incorrect.

Misdiagnosed children may not be considered “at risk” because
medication has appeared to ease the situation. However, they will most
likely be affected by a lack of self worth that the misdiagnosis has
instilled within them. This may ultimately lower a child’s professional
expectation and cause him to accept a vocation or profession lower than
his actual potential.

What would have happened had these children been introduced to a
behavioral vision approach? Not only could they have achieved success in
reading and learning but they may have actually reached their life’s
potential and subsequent joy.

Parents and child study team members may feel a false sense of security
believing that they’ve taken the child to the eye doctor who said, your
child’s eyes are fine, they see “20/20.” Seeing with clarity is
important and yet a child’s visual concerns may have nothing to do with
eyesight and everything to do with efficient, effective and effortless
eye coordination, focus and tracking ability.

A lack of visual coordination results in two sets of eye muscles not
working together. One muscle system controls focus, for clarity, while
the other system controls seeing single, not double. These two systems
are linked. Inaccuracy in one system will typically create a mismatch in
the other creating inefficiency between the two. Classical symptoms of
a motivated child trying to overcome visual dysfunction is eye strain
associated with excessive eye rubbing/burning, headaches after visual
activities and blurred vision during near activities. Symptoms of eye
avoidance, typical of an unmotivated child, are double vision,
omissions, or substituting words while reading, difficulty finishing
school work and the most common symptom loss of place while reading.
Nonreaders have no symptoms at all simply because they avoid any
situation which calls for them to read for any considerable length of
time.

The success of vision therapy depends on the motivation of the team:
inclusive of the child, parents and Behavioral Optometrist. If the
condition is recent and academic lags have not yet occurred, the program
is quite simple often resulting in complete remediation. When the
condition is long standing, academic and/or emotional concerns can
become secondary problems which must be addressed along with the primary
visual. The more complex the situation the more involved the treatment
strategy. When secondary issues are evident the team must include the
appropriate professionals. With academic involvement, reading, learning
and special education professionals need to be resourced. Social
workers/psychologists consulted if emotional concerns have surfaced.
Occupational and Physical therapists utilized for the development of
fine and gross motor skills and Speech and Language therapists
responsible for treatment of receptive and/or expressive language delay.

Parents, teachers and school administrators have the power to advocate
for our children especially when they realize that symptoms of these
labeled children can mimic behavioral vision dysfunction. Throw open
your child’s door of opportunity and success and advocate for your
bright and intelligent child’s ability to read, write and learn
accessing the freedom of visual self-discovery through the benefits of a
vision therapy program.

One of the most common and enthusiastic statements parents in my office
make is “guess what, my child just picked up a book to read all by
herself.”

Early and appropriate intervention is essential when changing a child’s
course of development from one of frustration and lack of ability to
one which encourages belief in oneself through success in a task.

About Dr. Warshowsky:

Joel H. Warshowsky is a behavioral and developmental Optometrist. He is
Associate Clinical Professor and founding Chief of Pediatrics at SUNY
State College of Optometry, where he has taught for over 35 years. He
served as Optometric Consultant to numerous schools for child
development throughout New York and New Jersey. Dr. Warshowsky has
lectured internationally and is published widely in the field of
optometry, and is a Fellow of the American Academy of Optometry and
College of Optometrists in Vision Development. He maintains two
pediatric practices in New York and New Jersey.

How Behavioral Optometry Can Unlock Your Child’s Potential:
Identifying and Overcoming Blocks to Concentration, Self-Esteem and
School Success with Vision Therapy can be purchased from www.amazon.com, www.barnesandnoble.com, www.jkp.com and through all major booksellers.

Exercising but aren't losing weight? Obsessed with counting each and every calorie you put in your mouth?

You might be caught in the 'numbers game.'

“Our society is obsessed by numbers, rules and strict diet plans, all
so we can fit into the ‘accepted’ body image, size and look,” says
Angela Lutz, a personal trainer and life coach with more than a decade
of experience in the health and fitness industry. “And it really only
leads to a society of people suffering from negative body images and
beliefs. We have to break free from that outlook."

Lutz explains her philosophy - as well as other tips on avoiding "disorderly eating" in her new health guide, Bound by Numbers.

Bound by Numbers is a thoughtful approach to healthy living
that begins by addressing internal issues first. Based on extensive
research and real-life examples, readers will learn how to jump off the
treadmill of harmful ideas and jump into a brand-new life free from the
past.